Pitt vs. Montefiore vs. Brown

[Freakingout]

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I'm having some difficulty ranking these programs. Prior to my interviews I was the most excited about UPitt, however, after my interview I felt differently.

While UPitt the instutition is very impressive the medicine program seems to coddle its residents. It has an attending run code service and there is an attending run overnight service that sees all new admissions. Now residents can work on the code team but it seemed to me like second years weren't very comfortable with code situations. Overall I think this is good for patients but I think I might learn more at a more "barebones" institution. The call schedule was 100% nightfloat which I believe also dampens the overall learning experience as I don't get to work up and follow the majority of the patients.

Montefiore seemed very much the opposite. Interns get their asses handed to them but are very, very strong by the time they begin their second year. The diversity in the Bronx is unbelievable and the patients are very sick.

Brown seemed more comparable to Montefiore though the intern year seemed less hellish and the people a little more friendly. I felt the training at Brown might be the best of all three programs.

For fellowship I'm thinking about Nephrology or ID. All of these programs seemed pretty comparable as far as where residents go. For Nephrology I think that UPitt has the lead at least according to USNews wheras I felt that Brown and Montefiore had better ID departments compared to UPitt.

What do you guys think? I was hoping that someone could dispell my impressions of UPitt as I liked the city quite a bit.

 

[VandyMed2009]

Hello!
I interviewed at both UPitt and Brown but not Montefiore, so I can comment on those 2 at least.

I don't think a few of the things you said about Pitt are accurate, but perhaps a Pitt resident can clarify? If not, I would definitely emial the PD to clarify. They do have overnight call -- they said they take call on Gen Med 3-4 times per month (anytime there team is on call on a Friday/Saturday, and when on long call during the week one intern stays overnight). They also have call on their ICU months.

As far as attendings running things, I am pretty sure the overnight attendings were only there as backup for quesetions, the residents do the admission and make the decisions on patient care.

Pitt and Brown actually seemed very similar to me in terms of the vibe of the program. The major difference I noticed were that Pitt has a VA system while Brown doesn't. Both are pretty light on call. Both seemed to have a pretty nurturing environment.

 

[DoctorSax]

Hey there--

Brown residents do rotate at the Providence VA. We do one month as interns and one month as seniors--all round an excellent experience (despite the occasional frustrations that befall all who work in a VA). The rest of the wards time is divided between the large urban/public Rhode Island Hospital and the smaller (but extremely high acuity) community/academic Miriam Hospital. It's a good balanced program that balances autonomy with supervision and "work" with excellent teaching and support. Pretty tight-knit kickass group of residents as well, if I do say so myself.

Can't speak to the pluses/minuses of Monte (other than the "social medicine" aspect, which seems to imply a focus on indigent care), but Pitt seemed like a great place when I interviewed there lo so many years ago--just wasn't for me.

Feel free to PM me with questions about Brown.

DS

 

[WorkaholicsAnon]

I can comment on the program at Pitt.

Residents definitely take call. Frequency and set-up of call will depend on which service you're rotating on.

UPMC Montefiore university hospital gen med floors - q5d long call non-overnight for residents except for Fri & Sat nights. Q10d overnight long for interns, alternating q10d nonovernight long. Interns on overnight call work with the night float resident after 6-7pm unless it's Fri or Sat in which case you are on with your own resident. Dont forget, you are also short call and intermediate call q5d in between, so most days you are admitting. Patients are often very complex, you will see unique pathology with some frequency here. It's a very busy service, and there's lots of learning. Decent autonomy (attending-dependent).

VA Hospital gen med floors - q4d long call alternating with q4d short call. Long call is nonovernight for the whole team except Fri & Sat, but you still stay until about 9-10pm on long call to wrap things up. Night float is there to help you get out, but at times they are getting slammed with admissions too. There is a good amount of bread and butter, but I've worked up lots of great cases on this service. Awesome teaching. Most of the time, autonomy is substantial (depending on the attending). Extremely busy during the winter months. Placement can be delayed so your patient list can get long.

Inpatient heme-onc floor - currently a very challenging set-up for both residents and interns, but undergoing active changes to improve learning quality on rotation per the PD. As it stands now, interns are q4d overnight long, largely autonomous at night doing admissions, and covering your own patients as well as those on the 3 other teams. Back up is available in the form of a busy heme-onc fellow (some are more helpful than others) and a resident moonlighter (until midnight). Residents are non-overnight, supposed to leave a 6pm, but must cover interns after noon post-call and after 5pm on non-call days because otherwise interns end up breaking the 80-hour rule. Also short call q4d in between longs. If you want code experience you will have quite a few here, though the pressure here is to pre-empt codes because if a patient codes it is often seen as lack of attention to detail, unless of course it is something unexpected like anaphylaxis. Your learning and quality of experience is highly attending and fellow dependent and variable.

CCU - q3d overnight call. All 3 intern/resident pairs follow all the patients on the CCU service. Very work-efficient set up. Sickest of the sick cardiac patients (3 patients ended up on ECMO in a span of 1 week when I was on service). You will have direct code experience here as patients do arrest with some frequency in the middle of the night. Excellent teaching and learning on this service. Back-up available in the form of a very busy in-house cards fellow. Attendings usually around late, most are approachable, and even available by phone from home in the middle of the night for urgent matters.

University hospital MICU - used to be q4d overnight but that way was often a madhouse because these patients are sickest of the sick, highly complex and patient loads would at times become very lopsided among teams (there was no cap). The structure has since changed for the better, so that each resident/intern pair is assigned to one of 3 floors, so that the maximum # of patients per team can be no greater than 8-10 (I forgot exactly how many beds per floor). There is also a 4th team that acts as "nightfloat". The 4 teams rotate positions weekly. The new structure was actually proposed by a resident (who has since graduated), which reflects how open the system is to suggestions for improvement. This is challenging service to be on, but you will learn tons on this service and get to do lots of procedures. Attendings I've worked with there are very supportive, as have been the fellows. You get some degree of autonomy, and expectations are high, but backup is definitely there.

VA ICU - q4 overnight call. Covers the VA CCU and MICU. Lighter patient load compared to the other ICUs, though can get busy with sick patients, especially in the winter months. After 6pm and on weekends, you are the chest pain code team. If you get to a regular code first, you are welcome to run it. There is an attending from the CCM attending-only service and a CCM fellow (not your daytime pulm fellow) who are in-house and also respond to codes. These are also your in-house backup during the night, and your own attendings also welcome you to call them at home in the middle of the night (REQUIRE you to call for certain situations). Depending on who the CCM attending is, they will usually let you keep running it; there are one, maybe two attendings who will just take over. Definitely a lot of autonomy since you and your resident are the only people from your own service who are in house overnight. Excellent learning rotation that is also not too overwhelming at the same time.

Inpatient cardiology floor - been a while since I did this rotation, so it's a little fuzzy but I believe it was q4d overnight call, not covered by nightfloat. You and your resident respond to codes, usually the intern is there first because the resident call room is further away, and the cards fellow can be tied up in a code in the CCU or something at the same time, so there is definitely autonomy that way. Usually management will depend on what the attending(s) want to do, as many patients on the service are under the care of their own primary cardiologist, so they will be like private patients.